Healthcare Provider Details

I. General information

NPI: 1023364676
Provider Name (Legal Business Name): CHEILA TAINA RODRIGUEZ IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7156 NABORS DR APT C
TINKER AFB OK
73145-4584
US

IV. Provider business mailing address

7156 NABORS DR APT C
TINKER AFB OK
73145-4584
US

V. Phone/Fax

Practice location:
  • Phone: 405-436-2710
  • Fax:
Mailing address:
  • Phone: 405-436-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: